ObjectivesOur study investigates the barriers perceived by staff in the referral systems in maternal healthcare facilities across Aceh province in Indonesia.DesignWith a cross-sectional approach, two sets of surveys were administered during September to October 2016 in 32 sampling units of our study. We also collected referral data in the form of the frequency of ingoing and outgoing referral cases per facility.SettingIn three districts, Aceh Besar, Banda Aceh and Bireuen, a total of 32 facilities including hospitals, community health centres, and private midwife clinics that met the criteria of providing at least basic emergency obstetric and neonatal care (BEonC) were covered.ParticipantsAcross the 32 healthcare centres, 149 members of staff (mainly midwives) agreed to participate in our surveys.Primary and secondary outcome measuresThe first survey consisted of 65 items focusing on organisational measures as well as case numbers for example, patient counts, mortality rate and complications. The second survey with 68 items asked healthcare providers about a range of factors including attitudes towards the referral process in their facility and potential barriers to a well-functioning system in their district.ResultsOverall, mothers’/families’ consent as well as the complex administration process were found to be the main barriers (36% and 12%, respectively). Healthcare providers noted that information about other facilities has the biggest room for improvement (37%) rather than transport, timely referral of mothers and babies, or the availability of referral facilities.ConclusionsThe largest barrier perceived by healthcare providers in our study was noted to be family consent and administrative burden. Moreover, lack of information about the referral system itself and other facilities seemed to be affecting healthcare providers and mothers/families alike and improvements perhaps through a shared information system is needed.
Oil palm frond (OPF) is one of potential sources of alternative feed, but has limited use due to high crude fiber and low crude protein contents. Fermentation is one of the methods widely applied to improve nutritive value of animal feed. The purpose of this research is to increase nutritive value of fermented oil palm fronds by adding different soluble carbohydrate source into fermentation media. The results of the experiments indicated that fermented oil palm fronds by Aspergillus niger had a significant effect (P<0,05) on the content of crude protein, crude fiber, and ash.Generally, fermented oil palm fronds with different soluble carbohydrate was able to increase the content of crude protein of oil palm fronds, but not optimal yet in reducing the crude fiber content of fermented substrate. However, the addition of rice bran on the fermentation medium showed the best results, characterized by increasing crude protein and decreasing crude fiber contents as well as improved dry matter and organic matter digestibility, reflected in high concentration of VFA.
Feed plays a significant role in livestock production worldwide. Digestibility of feed such as in vitro dry matter digestibility (IVDMD) and in vitro organic matter digestibility (IVOMD) as well as the fractions of crude fiber such as neutral detergent fiber (NDF) and acid detergent fiber (ADF) can be used as indicators of feed quality. To determine these nutritive parameters, several methods based on solvent extraction and other laboratory analyses are widely employed which are normally time consuming and may cause pollution since this analysis involves chemical materials. Near infrared spectroscopy (NIRS) is one of rapid alternative methods that can be considered to be applied due to its advantages. Therefore, the main objective of this present study is to apply NIRS in determining IVDMD, IVOMD, NDF, and ADF of animal feed samples simultaneously. Reflectance spectra were acquired for animal feed samples in wavelength range from 1000 to 2500 nm. Actual quality and nutritive values were measured by standard laboratory method. Spectra data were corrected by baseline shift correction (BSC), standard normal variate (SNV), and de-trending (DT). Prediction models were developed using principal component regression. Superior results for IVDMD, IVOMD, and NDF predictions were achieved using SNV with correlation coefficient (r) and RPD index of 0.93 and 2.78 for IVDMD, 0.90 and 2.35 for IVOMD, and 0.89 and 2.31 for NDF, respectively. ADF nutritive value was predicted accurately using DT spectrum with r and RPD index of 0.94 and 3.00, respectively. It may be concluded that NIRS can be used and applied as a rapid and simultaneous method in determining nutritive values of feed samples.
This cluster randomized clinical trial examines the effect of implementing the Safe Childbirth Checklist with medium-intensity coaching on the performance of essential birth practices in health care facilities in Aceh, Indonesia.
Abstract. Sugarcane bagasse is one of agro-industrial residues containing low nutrient content and difficult to be digested by animals. However, it can be recycled to produce value-added product such as protein-enriched animal feed by application feed technology such as ammoniation and fermentation. The purposes of these experiments were to evaluate the quality and in vitro digestibility of sugarcane bagasse by using two steps feed technology process: ammoniation and continued by fermentation process. Two studies were conducted in these experiments. The first study was to determine the quality of amoniated sugarcane bagasse after incubation at room temperature at different days (0, 7, 14, 21, 28 days) and the second study was to determine in vitro degestibility of ammoniated sugarcane bagasse fermented by using the various levels of sago flour (0%, 5%, 10% and 15% from sample total) and kept at room temperature for 21 day in an-aerobic condition. Parameters measured in this study were DM, CP, CF, pH, OM, IVDMD (in vitro dry matter digestibility), IVOMD (in vitro organic matter digestibility). The model used for the statistical analysis was completely randomized design (CRD). The results of the first study indicated that length of incubation was not significantly affect (P>0.05) on crude fiber content but had significant effect (P<0.05) on crude protein content but only for control treatment. For the second study concluded that administration of the various levels of sago flour into ammoniated sugarcane bagasse fermented with T.harzianum significantly influenced (P<0.05) on OM, IVDMD and IVOMD but had not significantly effect on pH value. The results of the study indicated that application 10% of soluble carbohydrate from sago flour was recommended for fermentation process based on the results of in vitro and fermented feed quality studies.Key Words: ammoniation, fermentation, sugarcane bagasse, quality feed, in vitro Abstrak. Ampas tebu adalah salah satu hasil produksi limbah industri pertanian dengan kandungan nutrisi dan daya cerna yang rendah. Tujuan dari penelitian ini adalah untuk mengevaluasi kualitas dan daya cerna secara in vitro ampas tebu dengan menerapkan teknologi pakan: amoniasi yang dilanjutkan dengan proses fermentasi. Dua percobaan dilakukan dalam penelitian ini. Percobaan pertama adalah menentukan kualitas dari ampas tebu yang telah diamoniasi dan difermentasi dengan lama pemeraman yang berbeda (0,7,14,21 dan 28 hari). Sementara penelitian kedua adalah penentuan daya cerna in vitro dari amapas tebu yang telah diamoniasi dan difermentasi selama 21 hari secara an-aerob dengan level karbohidrat terlarut (tepung sagu) yang berbeda (0%, 5%, 10% dan 15% dari total sampel). Parameter yang diukur dalam penelitian ini adalah kandungan bahan kering, protein kasar, serat kasar, pH, kecernaan bahan kering dan organik secara in vitro. Rancangan yang digunakan dalam penelitian ini adalah rancangan acak lengkap (RAL). Hasil dari penelitian pertama menunjukan bahwa lama inkubasi tidak berpengaruh (P>0,05) terh...
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